Tuesday, July 22, 2008

As of 9pm (EDT) July 20th, CDC has recognized 1,251 lab-confirmed cases of Salmonella Saintpaul across 43 states, the District of Columbia and Canada. At least 228 people have been hospitalized during this marathon, and two deaths may be at least partly attributable to the outbreak strain. Four of the infected Canadians traveled in the United States prior to becoming ill; the fifth case is still under investigation.

Based on the onset date profile graph posted by CDC, this outbreak shows every sign of winding down. And late yesterday afternoon, FDA announced the first isolation of the outbreak strain of Salmonella Saintpaul from a sample of produce – a jalapeño pepper imported from Mexico by Agricola Zaragoza, an importer/distributor based in McAllen, Texas. Zaragoza has recalled all of the jalapeño peppers shipped to its customers since June 30th.

Now that CDC and FDA are moving into the "mopping up" phase of this outbreak, we can start to tally what Salmonella Saintpaul has cost the US economy. We can – very conservatively – calculate the cost based on the actual number of lab-confirmed cases. We can also determine an estimated cost by extrapolating the lab-confirmed cases to include cases that were never reported to CDC. First, though, we need to determine a cost per case.

Cost Per CaseFortunately, a group of Canadian researchers studied the cost of gastroenteritis in Hamilton, Ontario (a mid-sized Canadian city with a well-respected teaching hospital). The study, which appeared in Journal of Food Protection in 2006, produced an estimated cost of CDN$1,089 per case. That figure included treatment costs, lost wages, and other concrete costs; it did not take into account "intangible" costs.

The Canadian estimate is more than two years old, but it is the best available. Medical costs, transportation costs and wages all have risen since then; however, we'll be conservative and use the Canadian data without adjusting for inflation. As the Canadian and US currencies are – essentially – at par, we can ignore any minor currency differences.

Cost of Lab-Confirmed CasesAt a cost per case of $1089, the 1,251 lab-confirmed cases tallied by CDC to date have cost the US economy approximately $1.36 million.

Cost of Estimated Number of Total CasesThe 1,251 lab-confirmed cases of Salmonella Saintpaul are only the tip of the outbreak iceberg. CDC estimates that there are 38 cases of Salmonella infection for every case that CDC hears about. That would put the actual size of the Salmonella Saintpaul outbreak at 47,538 cases. On that basis, this one outbreak has cost almost$52 million so far.

These calculations do not include the costs incurred by the US tomato growers, who have been devastated by this outbreak. Nor do they include the investigation costs incurred by FDA, CDC and state agencies.

Annual Cost of Food-borne Disease to US EconomyWhile on the subject, we also can estimate the annual cost of food-borne diseases. The most recent estimate – published in 1999 and long overdue for an update – is 76 million cases of food-borne disease each year. This translates – based on our cost/case estimate of $1,089 – to an annual cost to the US economy ofmore than $82.7 billion dollars.

To put these numbers into perspective, the entire FDA budget for the current year – including foods, drugs, and devices – is just $2.1 billion dollars. That's less than 3% of the annual cost of the food-borne diseases that FDA (and to some extent USDA) is mandated to prevent!

It's time to rethink the US strategy for attaining a safe food supply. The present system is a patchwork quilt of overlapping jurisdictions. It has been outgrown by rapid changes in the domestic food production and food processing industries, and by an exponential increase in food imports.

I propose that the next President form an independent Food Safety Commission. The Commission should be non-political (as opposed to by-partisan), and should receive testimony, briefs and proposals from industry, academia, consumers and regulators. The mandate should include:

Determine a current estimate of food-borne disease in the United States;

Recommend improvements to the current methods for reporting illnesses and detecting incipient outbreaks;

Review the present US food safety regulatory structure and compare its effectiveness with food safety regulatory structures adopted by other countries; and

Propose a new US food safety regulatory structure designed to respond more effectively to the current state of the US domestic and imported food supply.

It is vital that such a Commission be headed by an individual who does not owe loyalty to industry, regulators, or lobbying organizations. An individual who has no political axe to grind. An individual whose primary goal is to do whatever it takes to improve the safety of the country's food supply.

3 comments:

* Improve surveillance of bacterial and viral diseases. First responders - ER physicians and local doctors - need to be encouraged to test for pathogens and report findings directly to local and state health departments and the CDC promptly. Right now, for every person counted in an outbreak there are some 20 to 40 times those that are sick but never tested. The more we test, the quicker we know we have an outbreak and the quicker it can be stopped.

* These same governmental departments, whether local, state or federal, need to learn to “play well together.” Turf battles need to take a back seat to stopping an outbreak and tracking it to its source. That means resources need to be provided and coordination encouraged so illnesses can be promptly stopped and the offending producer - not an entire industry - are brought to heal.

* Require real training and certification of food handlers at restaurants and grocery stores. There also should be incentives for ill employees not to come to work when ill. We should impose fines and penalties on employers who do not cooperate.

* Stiffen license requirements for large farm, retail and wholesale food outlets, so that nobody gets a license until they and their employees have shown they understand the hazards and how to avoid them.

* Increase food inspections. While domestic production has continued to be a problem, imports pose an increasing risk, especially if terrorists were to get into the act. Points of export and entry are a logical place to step up monitoring. We need more inspectors - domestically and abroad - and we need to require that they receive the training in how to identify and control hazards.

* Reorganize federal, state and local food safety agencies to increase cooperation and reduce wasteful overlap and conflicts. Reform federal, state and local agencies to make them more proactive, and less reactive. This too requires financial resources and accountability. We also need to modernize food safety statutes by replacing the existing collection of often conflicting laws and regulation with one uniform food safety law of the highest standard.

* There are too few legal consequences for sickening or killing customers by selling contaminated food. We should impose stiff fines, and even prison sentences for violators, and even stiffer penalties for repeat violators.

* We need to use our technology to make food more traceable so that when an outbreak occurs authorities can quickly identify the source and limit the spread of the contamination and stop the disruption to the economy. When I buy a book on line I can track it all the way to my mailbox. However, we have yet to find the source of a tomato (or salsa) outbreak after months of sickening hundreds.

* Promote university research to develop better technologies to make food safe and for testing foods for contamination. Provide tax breaks for companies that push food safety research and employee training. Greatly expand irradiation of raw hamburger and other high-risk products.

* Improve consumer understanding of the risks of food-borne illness. Foster a popular campaign similar to Mothers Against Drunk Driving, which uses consumer power to promote a no-tolerance policy toward growers and companies that produce tainted food.

* Provide Presidential leadership on a topic that impacts every single one of us.